1. Socioeconomic concerns around End-of-Life Care Mary Ellen McGreevey Director of Social Services

2. Critical Issues Overall High of Cost of Health Care Increasing number of uninsured Increased co-pay requirements Inadequate Medicare/Medicaid Reimbursement

3. Inadequate Reimbursement Medicare/Medicaid reimbursement in not adequate to cover the costs of care for hospice patients FY 2000 report by Millman and Robertson “…shortfalls pose significant financial threats to the hospice programs across the country” Role of development director is critical to not- for-profit hospices

4. Inadequate Reimbursement Medicare originally established the Hospice Benefit to cover a 70-day length of service Current length of stay is 45 days Over the past 4 years it has been as low as 15-20 days

5. Inadequate coverage Antiretroviral and other life-sustaining drugs are non-covered items Other palliative measures such as chemotherapy and radiation are too costly for hospices to support This encourages “closer to death” enrollments

6. Inadequate increase in reimbursement rates Readmissions to hospitals (and therefore cost of patient care) are reduced through hospice However, in almost 20 years, hospice reimbursement has only doubled The average daily reimbursement increased only 3.42% from FY 2002 to FY 2003

7. Average Daily Reimbursement Increased only 3.42% from FY 2002 to FY 2003 Service2003-2004 Routine Home Care$132.03 Continuous Care$770.40 In-Patient Respite$133.52 General In-Patient$583.11 2004-2005 $135.47 $790.56 $137.17 $598.49

8. Impact on the uninsured Most patients present too late fro treatment Most need access to a county hospital Prior to hospice there is no medication coverage

9. Impact on the Uninsured The terminal disease reduces or terminates their employment “you work until the cancer eats you up” Risk for becoming homeless Homeless move from streets into a nursing home or family home Decreased opportunity to attend to “unfinished business”

10. Non-English Speaking population is at risk Housing multiple families together Undocumented status Lack of income Ineligible for city/state benefits Inadequate or no life insurance Desire to be buried in their country of origin

11. Strengths of Non-English speaking populations Family Church Community sense of responsibility to bury with respect, dignity and patient’s last wishes